Subject(s)
Anesthesia, General/classification , Preoperative Care/classification , Risk Assessment , Surgical Procedures, Operative/classification , Algorithms , Anesthesiology , Blood Loss, Surgical , Clinical Laboratory Techniques , Clinical Protocols , Humans , Minimally Invasive Surgical Procedures , Philosophy, Medical , Physician-Patient Relations , Practice Guidelines as Topic , Predictive Value of Tests , Risk Factors , Sensitivity and SpecificitySubject(s)
Anesthesiology/methods , Propofol , Child, Preschool , Humans , Infusions, Intravenous , Male , Operating RoomsSubject(s)
Anesthesia, Conduction/methods , Anesthesia, General/methods , Anesthesia, Local/methods , Genital Diseases, Female/surgery , Analgesia, Patient-Controlled/methods , Anesthesia, Conduction/standards , Anesthesia, General/standards , Anesthesia, Local/standards , Clinical Trials as Topic , Female , HumansABSTRACT
Case mix based on diagnosis-related groups (DRGs) was studied over 3 years for duration of stay and mean charges for a pediatric intensive care unit (PICU) and a general ward (WARD) population. Case mix variation for 2403 PICU and 14,552 WARD patients was analyzed, and a subset of 856 PICU and 2222 WARD patients examined for variations in duration of stay and mean charges in nine DRGs. Whereas case mix by DRG was consistent over time for both groups, the PICU case mix differed consistently from WARD case mix (P less than 0.001). After adjustment for inflation and for differences in case mix, average stay for the PICU was 10.7 days, versus 6.1 for the WARD (P less than 0.025), with a mean charge of $7172 per PICU and $2946 per WARD patient (P less than 0.01). Furthermore, the case mix-adjusted differences in duration of stay and mean charge between the PICU and WARD populations increased over time. Pediatricians will need to address DRG-based reimbursement systems that place intensive care units, and their institutions, at a significant financial disadvantage.
Subject(s)
Diagnosis-Related Groups , Intensive Care Units/economics , Adolescent , Child , Child, Preschool , Critical Care/economics , Fees and Charges , Humans , Infant , Infant, Newborn , Length of Stay , Maryland , Patients' Rooms/economics , Public PolicyABSTRACT
We report on the cases of two sisters with carotid body tumor (CBT) and present a literature review that assembles epidemiologic information on 88 familial and 835 nonfamilial CBT patients. The sex ratio (males/females) of 1.0 for familial CBT (0.7 for nonfamilial) and CBT reports with complete sibship information suggest autosomal dominant genetic transmission. As in other familial cancers, bilateral disease is significantly more frequent in familial (31.8% of cases) than in nonfamilial CBT (4.4%). However, there is no difference in age at diagnosis between familial and nonfamilial CBR. Thus, this adult-onset familial cancer does not completely fit the Knudson "two-step mutation" model of carcinogenesis. We also found that 6% of reported CBT patients developed second primary tumors, mostly other paragangliomas. This feature suggests that CBT may be part of a larger neurocristopathy syndrome of multiple tumors of cells of neural crest origin.
